Trajectories of Severe Exacerbations of Chronic Obstructive Pulmonary Disease and Their Relationship with Mortality Risk.

Autor: Golpe R; Servicio de Neumología, Hospital Universitario Lucus Augusti, Unidad Administrativa 4-A, C/Dr Ulises Romero, 1, 27002, Lugo, Spain. rafagolpe@gmail.com., Figueira-Gonçalves JM; Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.; University Institute of Tropical Diseases and Public Health of the Canary Islands, University of La Laguna, Santa Cruz de Tenerife, Spain., Amado-Diago CA; Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, Spain.; Instituto de Investigación Sanitaria de Cantabria IDIVAL, Universidad de Cantabria, Santander, Spain., Expósito-Marrero A; Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain., González-Ramos L; Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, Spain., Dacal-Rivas D; Servicio de Neumología, Hospital Universitario Lucus Augusti, Unidad Administrativa 4-A, C/Dr Ulises Romero, 1, 27002, Lugo, Spain., García-Talavera I; Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain., Esteban C; Servicio de Neumología, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
Jazyk: angličtina
Zdroj: Lung [Lung] 2022 Oct; Vol. 200 (5), pp. 601-607. Date of Electronic Publication: 2022 Sep 05.
DOI: 10.1007/s00408-022-00565-8
Abstrakt: Purpose: Acute exacerbations of COPD (AECOPD) are important factors contributing to mortality risk. The rate of exacerbations varies overtime. An inconsistent pattern of exacerbation occurrence is a common finding. The mortality risk associated with such a pattern is not entirely clear. Our objective was to assess the risk of mortality associated with various possible patterns of AECOPD trajectories.
Methods: This is a multicenter historical cohort study. Four different exacerbation trajectories were defined according to the incidence of severe AECOPD requiring hospital admission 2 years before and after the date of the first visit to the respiratory clinic-Consistent non-exacerbators (NEx): no AECOPD before or after the index date; consistent exacerbators (Ex): at least one AECOPD both before and after the index date; converters to exacerbators (CONV-Ex): no exacerbations before and at least one AECOPD after the index date; converters to non-exacerbators (CONV-NEx): at least one AECOPD before the index date, and no exacerbations after said date. All-cause mortality risk for these trajectories was assessed.
Results: A total of 1713 subjects were included in the study: NEx: 1219 (71.2%), CONV-NEx: 225 (13.1%), CONV-Ex: 148 (8.6%), Ex: 121 (7.1%). After correcting for confounding variables, the group with the highest mortality risk was Ex. The CONV-Ex and CONV-Nex groups had a mortality risk between Ex and NEx, with no significant differences between them.
Conclusion: Different possible trajectories of severe AECOPD before and after a first specialized consultation are associated with different mortality risks. An inconsistent pattern of exacerbations has a mortality risk between Ex and NEx, with no clear differences between CONV-Ex and CONV-NEx.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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